Medical Director - Texas Licensed (5pm-9pm CT)

About Judi HealthJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, andJudi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.Position SummaryThe Clinical Enterprise department provides clinical business support to the entire company and provides clinical support for Capital Rx’s clinical utilization management (UM) programs, consultative support to the Pharmacy and Therapeutics (P&T) process, formulary development, drug information services and client activities as assigned. This position will report to the Lead Medical Director. This position transacts UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to Capital Rx’s coverage policies. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a stakeholder across the enterprise.Position ResponsibilitiesMedical Director will complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients; governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriateMakes clinical determinations in accordance with medical necessity and criteriaPerforms scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to requesting prescribersFollow all internal procedures, job aids, and HIPPA guidelines to protect patient privacy and data securitySupport the Department’s responsibilities to provide peer-to-peer phone call support to physicians/prescribers who call the company with specific and general questions about our clinical programs, communications and utilization review decisionsCommunicates effectively and confidently with members to promote positive health outcomesActively participates in the development of utilization management (PA) criteria and clinical policy revisions/reviewsAbility to work in a fast-paced environment with shifting prioritiesWeekend on-call responsibilities (shared rotating call)Attention to detail and commitment to delivering high-quality workMinimum QualificationsMust be a graduate of an accredited Medical School and Residency ProgramActive Texas medical license, requiredNo history of disciplinary actions on Medical LicenseMinimum 5 years history of clinical practice with direct patient careSpecialty-Internal MedicineBoard certified by appropriate Medical Board (DO, MD)Be able to satisfy rotating weekend call schedule with another Medical DirectorPossess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of ColumbiaRequired annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employmentDemonstrated experience in clinical outcomes, working knowledge of medical statistics, regulatory agencies, and analytic programsAbility to work with virtual teams of pharmacistsTime management skills to meet organizational goalsKnowledge of PBM environment, quality improvement and UM practices in a managed care environmentKnowledge of and appreciation for requirements of regulatory and accreditation agenciesAble to manage multiple priorities and deadlinesExcellent verbal, written, interpersonal and presentation skillsStrong knowledge of clinical medicine, health care delivery and the ability to acquire new scientific and medical knowledgeProficiency with Microsoft Office applications. (e.g., MS Word, Excel, and PowerPoint minimum)Preferred QualificationsSubspecialty board certification in addition to internal medicine (i.e. Rheumatology, Gastroenterology)Willing to obtain additional medical licenseLicensed in multiple states. Unrestricted without disciplinary actions (AZ, NC, MN, MI, TN or others)This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.Remote, US Salary Range: $79,800 USD - $126,000 USDAll employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.